Case Study: Transfusion-Free Leukemia Treatment

The treatment of leukemia may be one of the only exceptions to the general rule at USC that all patients can be cared for bloodlessly. The effects of chemotherapy on the bone marrow are such that blood counts almost always plummet, requiring the use of blood products to keep the patient alive.

Although little can be done for leukemia patients who cannot or will not accept blood transfusions, says Alexandra M. Levine, M.D., professor and chief of hematology and medical director of the USC/Norris Cancer Hospital, at USC these patients are allowed to make a choice. And that choice is respected.

“Our view is that if a person for religious or other reasons will not take blood transfusions, and still understands the risk of chemotherapy, then we will be happy to help them,” says Levine. “Some have survived and some have not. But they have the choice here.”

In addition, scientists are continuing to look into ways to turn even this one exception around, to be able to treat leukemia bloodlessly. And they’ve begun to find their way, least in the treatment of one condition called acute promyelocytic leukemia (APL).

“There is a drug called all-transretinoic acid that often can treat APL without the need for a transfusion,” notes Dan Douer, M.D., director of the Bone Marrow Transplant Program at the USC/Norris Comprehensive Cancer Center. “We treated a Jehovah’s Witness patient with APL using an experimental intravenous form of this medication, and she entered into a complete remission for three years before relapsing.”

Douer then treated the patient with another experimental drug called arsenic trioxide. Again the patient went into remission — without the need for blood products. “This is a revolution in the treatment of leukemia, because both drugs are not chemotherapy agents,” Douer says. “You can’t treat leukemia without blood products, but APL is one form of cancer that responds to this medication.”

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